The following guest post is reprinted with permission from the blog of Alison Bass.  At a Harvard event last night honoring Paul Thacker, a former investigator for Senator Chuck Grassley, someone in the audience wanted to know how the topic of Thacker’s talk — Dollars for Doctors: Who owns your physician? — was related to the soaring cost of medical care in this country. A video of the talk is available here. As Thacker noted at the outset of his talk, Medicare and Medicaid now consume a larger portion of the federal budget than the Pentagon, and… Continue Reading

How awareness of heuristics can affect your practice

Richard Smith (@Richard56), the former editor of BMJ, sent out a tweet earlier today that is worth some reflection. Here it is: 85% of clinical research is waste because the question is unimportant, the design is not right, nothing is published, or the paper is biased What do you think? Is most research done today a waste? Are researchers really providing knowledge that is valid and useful?    

Editor’s Note: The following guest post by Daniela Lamas is reprinted with permission from Now@NEJM, a blog for physicians about NEJM. The woman slumps to the floor beside her office desk… No one sees her go down…  A colleague hears a thud and rushes in….. He calls her name… No response… He checks for a pulse: nothing… “Call 911!” he yells. EMS arrives quickly, and finds the co-worker panicked, but performing good quality chest compressions he learned in a life support class. The emergency medical technicians take over CPR while… Continue Reading

Every so often, one of my patients with no history of stroke or transient ischemic attack asks my opinion on what to do about a carotid ultrasound — not ordered by me — showing high-grade stenosis. I am a general internist, and I don’t obtain these studies in patients without a history of cerebrovascular symptoms. Guidelines don’t endorse carotid screening in such patients, yet they end up getting screened in various ways: Some cardiologists and vascular surgeons routinely get carotid studies in their patients with coronary disease; some clinicians order ultrasound… Continue Reading

Estimating probabilities subjectively can lead to indiscriminate testing.

Editor’s Note: The following guest post by Beth Waldron is reprinted with permission from ClotConnect, a valuable resource for patients about blood clots and clotting disorders. Waldron is the program director of the UNC-Chapel Hill Blood Clot Outreach Program. Prescription Assistance: When Patients Can’t Afford a Medication Beth Waldron, Program Director of the Clot Connect project, writes…. Approximately 1 in 5 people don’t take a medication prescribed to them because they can’t afford to pay for it [ref 1]. While the cost of some outpatient anticoagulation therapies can be substantial, failure to take an… Continue Reading

‘ Paris, where the European Society of Cardiology is currently holding its annual meeting, is one of the world’s great cities. Orlando is the world capitol of medical meetings. Here are just a few of the differences. (Thanks as indicated for the suggestions.) Paris has a bewildering variety of long-distance trains, commuter trains, and subways. In Orlando you can take a monorail to Disney World. Air conditioning in Orlando is ubiquitous. There is no French word for “air conditioning.” Nearly every restaurant in Orlando has waiters dressed in costumes. Waiters… Continue Reading